Fillable DEPENDENT VERIFICATION WORKSHEET (V4) (Grand Canyon University)

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DEPENDENT VERIFICATION WORKSHEET (V4) (Grand Canyon University)

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Page 1 of 3
DEPENDENT VERIFICATION WORKSHEET (V4)
2020 – 2021
Custom Verification
Your application for financial aid was selected for review in a process called “Verification”. Please submit the documentation
as soon as possible but no later than 120 days after your last day of enrollment, or by September 2021, whichever occurs
first. No funds will be disbursed until the verification process is completed. Failure to complete the verification process by
the deadline will result in your ineligibility for Title IV funds for the award year. The law states we have the right to ask you
for this information before awarding any federal aid. If there are differences between the information supplied on your
federal application and your financial documents, we will need to correct this information. We must review the required
information under the financial aid program rules (34 CFR, Part 668).
The Department of Education has requested that the institution verify certain items for a student selected for this review.
All verification items listed on this worksheet must be verified to determine Title IV eligibility.
To review the status of your awards, please visit your GCU Student Portal at http://gcuportal.gcu.edu/.
All fields are required to be completed. If you have any questions, please contact your GCU Student Services Counselor.
A. Student Information
STUDENT NAME: GCU STUDENT NUMBER: _________________________
Address: Date of Birth: ____________________________
City: State: Zip: Phone No.:___ _____________
P0108292019
B. High School Completion Status
For the 2020-2021 award year, we are required by the Department of Education to verify your high school completion status.
As this is documentation already required for admission into Grand Canyon University, our office will work with the Office of
Academic Records to determine if you have submitted the appropriate document(s) to confirm your high school completion
status.
If additional information is required, you will be contacted by your GCU Student Services Counselor and asked to provide a
copy of your high school diploma, high school transcripts indicating a graduation date, copy of a GED, etc.
Page 2 of 3
Notary’s Certificate of Acknowledgement
State of ________________________________ City/County of _____________________________________
On _______________________________, before me, _____________________________________________,
(Date) (Notary’s Name)
personally appeared, _____________________________________ and provided to me on basis of satisfactory
(Printed Name of Signer)
evidence of identification __________________________________ to be the above-named person who signed
(Type of government-issued photo ID)
the foregoing instrument.
WITNESS my hand and official seal ___________________________________________
(seal) (Notary Signature)
My commission expires on _____________________
(Date)
STUDENT NAME: GCU STUDENT NUMBER: ________________________
C. Proof of Identity/Statement of Educational Purpose: COMPLETE EITHER SECTION 1 OR SECTION 2
1. To be Signed in the Presence of a Grand Canyon University Official
A. The student must appear in person at GCU to verify his or her identity by presenting an unexpired valid government-issued
photo identification (ID), such as, but not limited to, a driver's license, other state-issued ID, or passport. The
institution will maintain a copy of the student's photo ID that is annotated by the institution with the date it was received
and reviewed, and the name of the official at the institution authorized to receive and review the student's ID.
B. In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose below.
Statement of Educational Purpose
I certify that I _____________________________________________ (Print Student Name) am the individual signing this
Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used for
educational purposes and to pay for the cost of attending Grand Canyon University for 2020-2021.
Student Signature: ______________________________________
Date: ___________________________
2. To be Signed in the Presence of a Notary
If the student is unable to appear in person at GCU to verify his or her identity, the student must provide to the institution the
following via mail to the address listed at the bottom of this page:
A. A copy of the unexpired valid government-issued photo ID that is acknowledged in the notary statement below, or that
is presented to a notary, such as, but not limited to, a driver's license, other state-issued ID, or passport; and
B. The original Statement of Educational Purpose provided below, which must be notarized. If the notary statement
appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the
Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I certify that I _____________________________________________ (Print Student Name) am the individual signing this
Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used for
educational purposes and to pay for the cost of attending Grand Canyon University for 2020-2021.
Student Signature: ______________________________________
Date: ___________________________
Mail this document and a copy of the photo ID presented (e.g. driver's
license) to the Notary to: Grand Canyon University, Office of Financial Aid,
P.O. Box 11549, Phoenix, AZ 85061.
California Notaries: Using the separate CA
notary form is acceptable as long as the type of
photo ID presented is noted on the form.
P0108292019
Page 3 of 3
STUDENT NAME: GCU STUDENT N
UMBER: ________________________
D. Certification and Signature (Handwritten Signature Required – Typed/Electronic Signature Not Accepted)
By signing below both student and parent whose information was reported on the FAFSA certify that all of the information
reported is complete and correct.
Student Signature: __________________________________________Date: _______________________________
Parent Signature: ___________________________________________Date: _______________________________
WARNING: If false or misleading information is purposely given on this worksheet, student/parent may be fined, sent to prison, or both
P0108292019
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DEPENDENT VERIFICATION WORKSHEET (V4) (Grand Canyon University)

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Completed 16 August 2020

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